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Vertical Banded Gastroplasty—Laparoscopic Surgery
(Stomach Stapling; Bariatric Surgery; Weight-Reduction Surgery)
Vertical banded gastroplasty, also called stomach stapling, is surgery that divides the stomach into 2 parts to treat obesity . It causes weight loss by decreasing the amount of food you can eat.
|This surgery involves re-shaping the stomach to reduce the amount of food it can hold.|
|Copyright © Nucleus Medical Media, Inc.|
Reasons for Procedure
The surgery treats severe obesity. A calculation called body mass index ( BMI ) is used to determine how overweight or obese you are. A normal BMI is 18.5-25.
This surgery is a weight loss option for people with:
- BMI greater than 40
- BMI 35-39.9 and a life-threatening condition or severe physical limitations that affect employment, movement, and family life
The success of vertical banded gastroplasty depends on your commitment. If lifestyle changes are made and maintained, the benefits of bariatric surgery include:
- Weight reduction
- Improvement in many obesity-related conditions
- Improved movement and stamina
- Enhanced mood, self-esteem, and quality of life
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Blood clots
- Breakdown of the staples, allowing stomach juices to leak into the abdomen
- Slipping or wearing away of the band
- Enlargement of the pouch
- Irritation of the throat due to acid reflux
- Hernia formation
- Complications of general anesthesia
Long-term complications include vomiting and gallstones.
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Chronic disease such as diabetes
What to Expect
Prior to Procedure
Each bariatric surgery program has specific requirements. Your program will likely include the following:
- Thorough physical exam and review of medical history
- Ongoing consultations with a registered dietitian
- Mental health evaluation and counseling
Leading up to your procedure:
- Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure.
- Do not start any new medications, herbs, or supplements without talking to your doctor.
- Arrange for a ride to and from the hospital.
- Arrange for help at home as you recover.
- You may be given antibiotics.
- You may be given laxatives and/or an enema to clear your intestines.
- The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.
- Shower or bathe the morning of your surgery.
General anesthesia will be used. You will be asleep for the surgery.
Description of the Procedure
The laparoscopic method begins with several small cuts made in the abdomen. Gas will be pumped in to inflate your abdomen. This will make it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor in the operating room. Your doctor will operate while viewing the area on this monitor.
Surgical staples will be used to divide your stomach into two unequal portions. The upper portion will be a small pouch. It will empty through a tiny opening into the lower portion. The small pouch can hold only ½ to 1 cup of soft, moist, and well-chewed food. A normal stomach can hold 4-6 cups.
Next, a plastic band will be wrapped around the tiny opening. This will prevent it from stretching. This band can be adjusted after surgery. The incisions will then be closed with staples or stitches.
Immediately After Procedure
The breathing tube will be removed. You will be taken to the recovery area.
How Long Will It Take?
About 2 hours
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
You will be in the hospital for 2-5 days. Your doctor may choose to keep you longer, however, if complications arise.
At the Hospital
While you are recovering at the hospital, you may receive the following care:
- Pain medication will be given as needed.
- Day of surgery—You will not eat or drink anything.
Day after surgery—You will likely have an
to check for leaks from the stomach pouch. You will drink a special liquid while x-rays are taken.
- If the x-ray is normal, you will be given 30 milliliters (mL) of liquids every 20 minutes.
- If leaks are found, you will receive nutrition through an IV until the leaks are fixed.
- On the second day after surgery—You will have 1-2 tablespoons of pureed food or 1-2 ounces of liquids every 20 minutes.
You may be asked to do the following:
- Use an incentive spirometer to take deep breaths every hour to prevent breathing problems.
- Wear elastic surgical stockings or boots to promote blood flow in your legs.
- Get up and walk daily.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chance of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
You will need to practice lifelong healthy eating and exercising habits. After your surgery:
- Do not lift anything heavy for at least 2 weeks.
- You may have emotional changes after this surgery. Your doctor may refer you to a therapist.
- You will meet regularly with your healthcare team for monitoring and support.
Your new stomach is the size of a small egg. It is slow to empty. This will make you feel full quickly. Nutritional steps include:
- You need to eat very small amounts and eat very slowly.
- You will begin with 4-6 small meals per day. A meal is two ounces of food.
- For the first 4-6 weeks after surgery, all food must be pureed.
- When you move to solid foods, food must be well-chewed.
- When making food choices, ensure that you are getting enough protein.
- Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.
- This procedure does not cause nausea and diarrhea if sweet or fatty foods are eaten. In fact, some people gain back weight because they continue to consume high-calorie foods. To promote ongoing weight loss, avoid high-calorie foods.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Persistent cough, shortness of breath, or chest pain
- Worsening abdominal pain
- Blood in the stool
- Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
- Persistent nausea or vomiting
- Pain and/or swelling in your feet, calves, or legs
- New or unexpected symptoms
If you think you have an emergency, call for emergency medical services right away.
American Society for Metabolic and Bariatric Surgery
National Institute of Diabetes and Digestive and Kidney Diseases
Weight Loss Surgery
Bariatric surgery. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T483434/Bariatric-surgery . Updated October 23, 2017. Accessed December 22, 2017.
Bariatric surgery. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/nutritional-disorders/obesity-and-the-metabolic-syndrome/bariatric-surgery. Updated December 2016. Accessed December 22, 2017.
Bariatric surgery. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery. Accessed December 22, 2017.
Maciejewski ML, Livingston EH, Smith VA, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305(23):2419-2426.
9/2/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T483434/Bariatric-surgery : The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445-454.
6/24/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T483434/Bariatric-surgery : Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484-487.
- Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
- Review Date: 11/2018
- Update Date: 12/20/2014